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Background and purpose: Knowledge about the seizure prevalence in the whole symptomatic course, from disease onset to death, in neurodegenerative diseases (ND) is lacking. Therefore, the aim was to investigate seizure prevalence and associated clinical implications in neuropathologically diagnosed ND. Methods: Clinical records of cases from the Neurobiobank Munich, Germany, were analyzed. Neuropathological diagnoses of the assessed cases included Alzheimer disease (AD), corticobasal degeneration (CBD), frontotemporal lobar degeneration (FTLD), Lewy body disease (LBD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). Seizure prevalence during the whole symptomatic disease phase was assessed and compared amongst ND. Associations between first clinical symptom and seizure prevalence and between seizures and disease duration were examined. Results: In all, 454 patients with neuropathologically diagnosed ND and with available and meaningful clinical records were investigated (AD, n = 144; LBD, n = 103; PSP, n = 93; FTLD, n = 53; MSA, n = 36; CBD, n = 25). Seizure prevalence was 31.3% for AD, 20.0% for CBD, 12.6% for LBD, 11.3% for FTLD, 8.3% for MSA and 7.5% for PSP. Seizure prevalence was significantly higher in AD compared to FTLD (p = 0.005), LBD (p = 0.001), MSA (p = 0.005) and PSP (p < 0.001). No other significant differences regarding seizure prevalence were found between the studied ND. Cognitive first symptoms in ND were associated with an increased seizure prevalence (21.1% vs. 11.0% in patients without cognitive first symptoms) and motor first symptoms with a decreased seizure prevalence (10.3% vs. 20.5% in patients without motor first symptoms). Seizures were associated with a longer disease duration in MSA (12.3 vs. 7.0 years in patients without seizures; p = 0.017). Conclusions: Seizures are a clinically relevant comorbidity in ND, particularly in AD. Knowledge of the first clinical symptom in ND may allow for estimation of seizure risk. [ABSTRACT FROM AUTHOR]

Background and purpose: Clinical diagnostic criteria for neurodegenerative diseases have been framed based on clinical phenomenology. However, systematic knowledge about the first reported clinical symptoms in neurodegenerative diseases is lacking. Therefore, the aim was to determine the prevalence and clinical implications of the first clinical symptom (FS) as assessed by medical history in neuropathologically proven neurodegenerative diseases. Methods: Neuropathological diagnoses from the Neurobiobank Munich, Germany, were matched with clinical records for analyses of the diagnostic and prognostic values of FSs. Results: In all, 301 patients with the neuropathological diagnoses Alzheimer disease (AD), progressive supranuclear palsy (PSP), frontotemporal lobar degeneration (FTLD), Lewy body disease (LBD) including the neuropathologically indistinguishable clinical phenotypes Parkinson disease and dementia with Lewy bodies, multiple system atrophy (MSA) and corticobasal degeneration (CBD) were studied. Memory disturbance was the most common FS in AD (34%), FTLD (19%) and LBD (26%), gait disturbance in PSP (35%) and MSA (27%) and aphasia and personality changes in CBD (20%, respectively). In a model adjusting for prevalence in the general population, AD was predicted by memory disturbance in 79.0%, aphasia in 97.2%, personality changes in 96.0% and by cognitive disturbance in 99.0%. Gait disturbance and tremor predicted LBD in 54.6% and 97.3%, coordination disturbance MSA in 59.4% and dysarthria FTLD in 73.0%. Cognitive FSs were associated with longer survival in AD (12.0 vs. 5.3 years; p < 0.001) and FTLD (8.2 vs. 4.1 years; p = 0.005) and motor FSs with shorter survival in PSP (7.2 vs. 9.7; p = 0.048). Conclusions: Assessing FSs in neurodegenerative diseases may be beneficial for accuracy of diagnosis and prognosis and thereby may improve clinical care and precision of study recruitment. [ABSTRACT FROM AUTHOR]

The German BMBF (German Ministry of Education and Research) has decided to establish an Integrated Center for Research and Treatment (IFB^{LMU}) of Vertigo, Balance and Ocular Motor Disorders in Munich in 2010. With funding of \psfig{figure=eur.eps,width=1.8mm}50 million over a ten-year period, the long-term continuation of the IFB^{LMU} is envisioned. [ABSTRACT FROM AUTHOR]

Abstract: Background: Due to the lack of epidemiological data on the relation of dizziness and anxiety, we investigated the prevalence of dizziness and anxiety in a representative sample of the German population. We explored the consequences of comorbid anxiety for emotional distress, functional impairment, health care utilization, and health behavior in dizziness. Methods: By the end of 2006, we surveyed a total of 1287 persons between 14 and 90 years of age in their homes by trained interviewers with standardized self-rating questionnaires on anxiety (Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Mini-Social Phobia Inventory) and dizziness (Vertigo Symptom Scale). The sample was representative for the German population in terms of age, sex, and education. Results: Symptoms of dizziness were reported by 15.8% of the participants. Of the participants with dizziness, 28.3% reported symptoms of at least one anxiety disorder (generalized anxiety, social phobia, panic). Persons with dizziness reported more somatic problems such as hypertension, migraine, diabetes, etc. Comorbid anxiety was associated with increased health care use and impairment. Conclusion: Dizziness is a highly prevalent symptom in the general population. A subgroup with comorbid anxiety is characterized by an increased subjective impairment and health care utilization due to their dizziness. Because treatment options for distinct neurotologic disorders are also known to reduce psychological symptoms, and in order to avoid unnecessary medical treatment, early neurologic and psychiatric/psychotherapeutic referral may be indicated. [Copyright &y& Elsevier]

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Objective: To determine feasibility and safety of stroke care organization within our Neurovascular Network of Southwest Bavaria (NEVAS) in a rural area with distances of up to 100 kilometers, we compared patients who underwent mechanical thrombectomy (MT) in large vessel occlusion admitted directly to our center (direct to center [DTC]) to patients who were transferred for MT via NEVAS (drip and ship [DS])., Methods: This is a retrospective analysis of prospectively collected data of all MT patients between January 2015 and May 2018. Successful recanalization was defined as a thrombolysis in cerebral infarction score of 2b-3. Symptomatic intracerebral hemorrhage (sICH) was defined according to European Cooperative Acute Stroke Study 3. Modified Rankin Scale (mRS) score of 0-2 at 3 months indicated good outcome., Results: MT was performed in 410 patients: 221 DTC and 189 DS. Median NIH Stroke Scale (NIHSS) score was 16 and premorbid mRS score was 0. Thrombolysis was applied in 62.2% with the same time from symptom onset in both groups (94.5 vs 95 minutes). Successful recanalization (79.3% vs 77.8%) and NIHSS score reduction from admission to discharge (16-7 vs 17-6) were comparable. Time delay from onset to revascularization was 96 minutes in DS (212 vs 308 minutes, p = 0.001). At follow-up, DTC patients had a trend to better outcome (33.5% vs 24.3%, p = 0.056). Neither sICH (6.3% vs 5.9%, p = 0.840) nor mortality (31.2% vs 34.4%, p = 0.387) differed between the groups., Conclusion: DS patients benefit from MT without relevant safety concerns, but with a trend to unfavorable outcome compared to DTC patients. These results suggest that DS is suitable to provide MT in rural areas where DTC is not possible., (© 2019 American Academy of Neurology.)

Objectives: To evaluate daily life management and functional outcome of Idarucizumab administration in case of emergency situations in patients with Dabigatran treatment., Design: Multicenter observational registry study., Setting: All hospitals with full neurological departments (n = 6) in Munich, Germany INCLUDED PATIENTS: All patients treated with Idarucizumab from 01/2016 to 03/2019., Analyzed Data: Indication and application of Idarucizumab, demographics and clinical parameters, and further interventions and treatments; clinical outcome was assessed with the modified Rankin scale (mRS) at 3 months after Idarucizumab administration RESULTS: Idarucizumab was administered to 32 patients for severe bleeding complications and ischemic strokes, more precisely for the following specific indications: intracranial bleeding (17 patients, 53%), ischemic stroke (8 patients, 25%), gastrointestinal bleeding (3 patients, 9%), femoral fracture, aortic dissection, and abdominal trauma and ileus (1 patient each, 3%). Additional coagulation management was performed in 7 patients (22%). Nine patients (28%) underwent emergency surgery. Seven patients (22%) received Idarucizumab before intravenous thrombolysis due to ischemic stroke and 4 of these 7 patients (13%) received mechanical thrombectomy in addition. Indication was mainly based on the history of Dabigatran intake and was irrespective of laboratory testing. At follow-up, 25% of the investigated patients had a mRS 0-2, while 25% had an unfavorable outcome (mRS 4-5). Mortality was 31%., Conclusion: In our study, we have shown that the administration of Idarucizumab is a rare intervention and restricted to patients with severe bleeding complications or ischemic stroke. The clinical outcome of patients who received Idarucizumab in emergency situations was poor.

Background: Vertigo and dizziness are often not fully explained by an organic illness, but instead are related to psychiatric disorders. This study aimed to evaluate psychiatric comorbidity and assess psychosocial impairment in a large sample of patients with a wide range of unselected organic and non-organic (ie, medically unexplained) vertigo/dizziness syndromes., Methods: This cross-sectional study involved a sample of 547 patients recruited from a specialised interdisciplinary treatment centre for vertigo/dizziness. Diagnostic evaluation included standardised neurological examinations, structured clinical interview for major mental disorders (SCID-I) and self-report questionnaires regarding dizziness, depression, anxiety, somatisation and quality of life., Results: Neurological diagnostic workup revealed organic and non-organic vertigo/dizziness in 80.8% and 19.2% of patients, respectively. In 48.8% of patients, SCID-I led to the diagnosis of a current psychiatric disorder, most frequently anxiety/phobic, somatoform and affective disorders. In the organic vertigo/dizziness group, 42.5% of patients, particularly those with vestibular paroxysmia or vestibular migraine, had a current psychiatric comorbidity. Patients with psychiatric comorbidity reported more vertigo-related handicaps, more depressive, anxiety and somatisation symptoms, and lower psychological quality of life compared with patients without psychiatric comorbidity., Conclusions: Almost half of patients with vertigo/dizziness suffer from a psychiatric comorbidity. These patients show more severe psychosocial impairment compared with patients without psychiatric disorders. The worst combination, in terms of vertigo-related handicaps, is having non-organic vertigo/dizziness and psychiatric comorbidity. This phenomenon should be considered when diagnosing and treating vertigo/dizziness in the early stages of the disease., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

The Vertigo Handicap Questionnaire (VHQ) by Yardley (1992) assesses physical and psychosocial impairments of vertigo or dizziness. Our study examines the structure, reliability, and aspects of validity of the German version of the VHQ. 98 vestibular vertigo syndromes vs. 90 patients with somatoform vertigo and dizziness were evaluated with the VHQ, symptom severity (VSS), distress (GSI), anxiety and depression (HADS), catastrophizing beliefs (ACQ), fear of body sensations (BSQ), and quality of life (SF-36). For diagnostic classification detailed clinical neurological, neuro-otological and psychosomatic testing were conducted. Principal components analysis identified two factors, which could be confirmed by confirmatory factor analyses: 'handicapped activity'(VHQ-ACT) and 'anxiety' (VHQ-ANX). The VHQ had good internal consistency (Cronbach's alpha: 0.92). Test-retest reliability was r = 0.80. We noted close relations between the VHQ, the VSS and measures of emotional distress as aspects of good construct validity. Together with the VSS, the VHQ completes a comprehensive diagnostic screening tool for vertigo or dizziness., (© Georg Thieme Verlag KG Stuttgart · New York.)

This study aimed at identifying gender-specific differences in stroke knowledge, stroke risk perception and the educational effects of a multimodal educational intervention. We performed computer-assisted telephone surveys among an average sample of 500 members of the general public (44.0% male, 56.0% female), before and immediately after an intense 3-month educational stroke campaign in a western German area of 400,000 inhabitants. The intervention was comprised of poster advertisements and various print media. Slogans and stroke interest stories appeared regularly in local newspapers, on television and radio and public events focussed on the subject. Even before the intervention, more women than men were able to name at least one stroke warning sign (71.3 vs. 57.8%, p < 0.01), to name the correct emergency call number (33.3 vs. 24.3%, p < 0.05) or to cite the correct action in acute stroke ("call emergency care", 87.2 vs. 70.1%, p < 0.001). In some aspects women showed a generally better improvement of knowledge after the campaign (e.g. correct emergency call number: +5.7 vs. +1.2%, p < 0.05). Fewer women than men considered themselves as being at risk of stroke (30.9 vs. 36.9%. p < 0.01) with a significant increase following the intervention in both sexes (38.9/46.0%, p < 0.01). The perception of different educational media varied between the sexes. For example, female sex was independently associated with a better recall of poster advertisements and flyers in pharmacies and at the doctor's office (OR 1.44). Our data indicate that educational programs do have gender-specific effects. Women show a better stroke knowledge and in some aspects a better chance to gain information from classical broad educational interventions. Future campaigns should be tailored economically, and should focus different media and educational messages on the two sexes accordingly.

To study the differential educational effects of a multimodal educational program on public stroke knowledge, we performed computer-assisted telephone surveys among a random sample of 500 members of the general public, before and immediately after an intense three-month educational campaign. The intervention comprised of poster advertisements, flyers, mail circular, slogans, stroke interest stories etc. in local newspapers, on television and radio, and public events. The main outcome measures were stroke knowledge, the intended behavior in acute stroke and the educational media remembered after the intervention. General knowledge of the nature of stroke (65.7% correct answers before versus 84.9 % after the campaign, p < 0.01) and the awareness of being at risk of stroke (32.7 % vs. 41.9%, p < 0.01) increased due to the campaign, especially in respondents of lower educational background. There was no significant effect on the number of patients who would seek emergency medical care after the intervention (81 % vs. 82 %) and hardly any effect on detailed knowledge of stroke warning signs or different risk factors. Mass media like newspapers, radio and television were most frequently reported as the main information source remembered (66.6 %). Our data indicate that educational programs do have differential effects on public stroke knowledge and individual stroke risk,which does not necessarily lead to a change in care-seeking behavior. Repeated information using short-tailored slogans and cues to action led to a gain in general stroke knowledge, especially in high-risk populations of lower educational background. Large educational campaigns seem unsuitable, however, for mediation of detailed information on stroke.